Moral distress amongst veterinary surgeons

RE: Moral distress amongst veterinary surgeons

Martin Atkinson — Fri, 26 Oct 2018 18:05:14 GMT

[quote user="Julie Innes"]

I called the police just in case he came down, so hopefully they have logged that, they took my details and told me to call 999 if he appeared.[/quote] We have a panic button behind reception attached to the alarm system, it's instant so the baddie can't grab the phone off you as you ring 999.

[quote user="Julie Innes"]I've written a note on his file, especially so that the next practice to get this nasty little man as a client has a heads up (or is that against new GDPR rules??)[/quote]I feel this would another thing that would be under the caveat of legitimate interest or vital and public interest.

[quote user="Clare Tapsfield-Wright"]I bet your Dad was delighted to be asked for help and give moral support plus some hands on repair. It will have made his day. [/quote]Agreed. Nobody messes with daddy's girl or I will mess with them!

RE: Moral distress amongst veterinary surgeons

Julie Innes — Wed, 24 Oct 2018 18:33:39 GMT

[quote user="Clare Tapsfield-Wright"]Julie thanks , that has made me smile. I bet your Dad was delighted to be asked for help and give moral support plus some hands on repair. It will have made his day.[/quote]

He was! He was down at the surgery within 5 minutes of him putting the phone down! I guess we never stop looking to our parents for help, even at the ripe old age of 45!! I think he felt like the white knight, and was quite chuffed!

RE: Moral distress amongst veterinary surgeons

Clare Tapsfield-Wright — Wed, 24 Oct 2018 17:45:53 GMT

Julie thanks , that has made me smile. I bet your Dad was delighted to be asked for help and give moral support plus some hands on repair. It will have made his day.

RE: Moral distress amongst veterinary surgeons

Julie Innes — Wed, 24 Oct 2018 12:29:31 GMT

Thanks all, and sorry to derail the thread! I called the police just in case he came down, so hopefully they have logged that, they took my details and told me to call 999 if he appeared. I also called my dad! Yeah, he's 71, but just made me feel better having him there! Lots of witnesses to the phone call(s) and I've written a note on his file, especially so that the next practice to get this nasty little man as a client has a heads up (or is that against new GDPR rules??)

I agree, I won't tolerate bullying and abuse! Had he apologised for non-payment, given me a reason (he has apparently "moved f***ing house!" so never received the invoices (hmm)) and been reasonable I would have been fine, but he came on like a nutter from the word go! He was apparently looking to book an ultrasound, so I have a feeling he is trying to breed his French bulldog. This guy + pregnant Frenchie sounds like a disaster waiting to happen to me, so dodged a bullet there!

Oh, and while my darling dad was hanging about the surgery waiting for the loony to show, he FIXED MY DENTAL HANDPIECE !! Apparently the barrel had moved and the hole was misaligned so the air wasn't getting through to drive the wee turbine thingummies and he can't believe I didn't think of that, given that it took him about 4 minutes to work it out

RE: Moral distress amongst veterinary surgeons

Bob Russell — Wed, 24 Oct 2018 09:45:31 GMT

I would tend to agree that everything should be documented. I have little fear of the RCVS but it should provide some evidence for the Police should anything turn into regular unwanted contact.

With the 'just turn up at any hour' mentality a good deal of the professional distance has been eroded in recent years. Owners feel empowered and some expect to get there own way even if it means shouting and bullying.

That will not work in our practice. Everyone works hard to care for client and patient alike but there have to be some rules for the sake of sanity.

RE: Moral distress amongst veterinary surgeons

Iain Richards — Wed, 24 Oct 2018 09:20:29 GMT

And write down your exact recollection and exact course of action and keep it one file, just in case this, "person" puts in an RCVS complaint.

RE: Moral distress amongst veterinary surgeons

Clare Tapsfield-Wright — Tue, 23 Oct 2018 18:54:35 GMT

My sympathy Julie , what a nasty piece of work. You and your staff are well rid of him so well done for standing up to him. Might be worth recording a statement of his threatening behaviour just for the record. Most bullies like this have bigger fish to fry so don’t worry too much.

RE: Moral distress amongst veterinary surgeons

Julie Innes — Tue, 23 Oct 2018 18:00:19 GMT

[quote user="Bob Russell"]Good to be the boss sometimes![/quote]

I think being the boss is the most stressful bit! Had a charming client on the phone today who we had removed from our list for non-payment a few months ago(after sending several reminders, I send a letter saying if they dont pay within 7 days we will remove them from the list). He was rude to my receptionist yesterday when she advised she couldn't give him an appointment without speaking to me. I had a note to call him today, which I was going to do after ops. He called again midmorning to shout about the fact I hadn't called him back, so I called him after I finished the femoral head excision and got a torrent of abuse, shouting and swearing. I told him I didn't think the "conversation" was going anywhere, he suggested I "hang up on me, then", so I did. He then called another 4 times in succession and shouted at various nurses. Finally I got him on the phone and he told me "I'm on my way down!"

From what we have seen of this guy we suspect he is a drug dealer, so I wasn't too thrilled at the prospect of him coming down, and told him if he did I would call the police. He hung up, still threatening to come down. So I waited. And waited. He never did show up, but he still managed to ruin my day, even though this time I know I was in the right! I'm still worried about what he might do next . Happy days

RE: Moral distress amongst veterinary surgeons

Bob Russell — Tue, 23 Oct 2018 10:05:33 GMT

I think the term 'moral distress' is a load of bull.

I doubt that many vets are overly worried about the morality of their decisions.

I wholeheartedly agree that this is ignoring the fundamental problems that many vets face. I suspect many feel powerless in the face of obstructive clients, they face difficult working conditions and sometimes lack of support. At the end of the day the pay does not reflect these pressures either.

I have some degree of control which helps.

A client last week refused to let me take dental X-rays if required. She told a staff member that she believed this was a new toy and I just wanted to use it because!

The staff member was quite upset because she knows we have been doing dental radiography for donkeys years, nothing is new and I will only X-ray where I feel there is justification.

I phoned her back and discussed this and suggested eventually she may be happier with another vet!

This has helped the practice because it has made it clear to everyone that the client is not in charge and whilst we respect them, we expect respect back. A much happier practice as a result and a difficult client will be causing hassle elsewhere.

Good to be the boss sometimes!

RE: Moral distress amongst veterinary surgeons

Robert FalconerTaylor — Tue, 23 Oct 2018 06:05:27 GMT

[quote user="Wren"]

[quote user="George Cooper"]To those who rail against the poor, the underprivileged, the dense, the thoughtless and say things like "if you cannot afford treatment (and thus won't upset ME the vet) - then DONT GET A DOG" - just spare a thought for the OTHER times when those people don't need a vet - the joy and companionship that, in their situation, is their only reason to perhaps get out of bed in the morning. Sometimes we do ourselves no good at all when we choose not to see another side to the particular coin that has been tossed.[/quote]

I absolutely agree. I figure my dog probably saves the NHS a considerable amount of money - definitely some days my only reason to get out of bed, or the only reason I'll put my running shoes on in the rain and get us both some exercise. We are quick to judge. What about people who got their dogs when they were financially secure, but their circumstances have changed? There but for the grace of god etc.....

[/quote]

A bit our of date now but re- cost/worth of pets some interesting history and numbers

http://www.emotions-r-us.com/politics/pets-and-taxation-are-we-paying-too-much/

RE: Moral distress amongst veterinary surgeons

Chris Milligan — Tue, 23 Oct 2018 04:32:17 GMT

This study touches on some important issues for sure but I worry it has glossed over some of the things that really bring anxiety to vets. I believe many vets don't sit at home every night agonising over whether or not they should have euthanased x patient to the nth degree and I worry this sometimes gets to be the main focus of commentary on wellbeing of veterinary surgeons because we feel like that's what our clients and patients expect of us.

The things that do real damage are still largely unaddressed; accusations of profiteering on a daily basis - not usually for patients that end up being euthanased, but trivial things like the cost of flea treatment or ongoing skin cases; a lack of ability to correct people directly or in a public forum due to confidentiality rules; shitty employment standards and frank exploitation in some cases; loneliness (prevalent but not restricted to) recent grads working away from home or cities they studied in; board complaints whether justified or (more usually) not and the lack of supportive services; general ignorance on behalf of the public, the media and indeed certain large scale business-oriented bosses in the profession of what vets are actually for and what our mandates are; feeling understaffed and overworked (an increasing problem and only going to get worse with dear old Brexit). These are issues that are unaddressed and deflected by studies like this.

RE: Moral distress amongst veterinary surgeons

Julie Innes — Mon, 22 Oct 2018 13:57:17 GMT

I absolutely do not think that only rich people should get a dog, that was not what I meant. I'm more than realistic about the fact that the majority of people won't have £XXK to spend on their pet at the drop of a hat. Its lack of basic care that I don't like- the dog that is never walked and whose nails are curling into its feet or, as someone mentioned upthread, the old arthritic dog that can hardly walk but has "never needed to see a vet". People who pay £30 every 3 weeks for their dog's haircut, but won't pay for vaccinations/ wormers/ medication. I work with several clients who don't have a lot of money but love their animals and we do all we can for them, I have a lot of time for people like that.

RE: Moral distress amongst veterinary surgeons

Lucy Fleming — Mon, 22 Oct 2018 12:51:59 GMT

All so true, and I think that the vast majority of veterinary surgeons are very pragmatic and flexible about providing (wherever possible) a low cost basic option that will provide something to improve the pet's quality of life without placing undue burden on the owner. Lack of funds for 'involved' veterinary care shouldn't preclude pet ownership (though I can certainly understand frustration with those who are already in an impecunious state and manage to acquire the money for an expensive new puppy, but not for any subsequent treatment needed). These are often the patients and clients that will benefit most from a regular health check to detect any changes early, when they are often (not always) more simple to treat.

I still see cases on a semi-regular basis where the owners have avoided coming in as they think that PTS will be advised or required...often if they had been seen earlier the condition would have been more manageable, and sometimes rather ironically by the time they do pluck up the courage to come in the PTS that they were so dreading becomes the only sensible option Finding a way to 'get the word out' to these clients that don't have a regular contact with the vets can be tricky!

RE: Moral distress amongst veterinary surgeons

Anthony Dennison — Mon, 22 Oct 2018 10:38:55 GMT

[quote user="Wren"]We are quick to judge. What about people who got their dogs when they were financially secure, but their circumstances have changed? There but for the grace of god etc.....[/quote]

Funny you should say that...

https://www.streetvet.co.uk/helping-homeless-pets/the-long-walk-for-streetvet/

This guy walked through my area over the weekend. My friend helped him out with a place to stay (he pitched his tent in the garden) and repaired the wheels on his trolley.

RE: Moral distress amongst veterinary surgeons

Wren — Mon, 22 Oct 2018 09:46:48 GMT

RE: Moral distress amongst veterinary surgeons

Thomas Johnson — Mon, 22 Oct 2018 09:06:16 GMT

[quote user="Clare Tapsfield-Wright"]We cannot always save their lives but we can often save animals from suffering when we are allowed to, and that might mean PTS in an animal that could survive but where owners circumstances prevent it . I consider a peaceful painless death which prevents suffering as the only course of action I can take sometimes.[/quote]

I completely agree with this. I was recently presented with an older cat that was a bit lethargic and off its food. On clinical examination I found that it had a heart rate of 280, a grade 4 heart murmur, some increase in respiratory effort and a large goitre. I thought it likely that the cat was going in to heart failure with HCM secondary to hyperthyroidism. I discussed everything with the owner and particularly the reasonable chance that if we could get the hyperthyroidism under control some of the cardiac changes would reverse and while it would need cardiac medication we could probably give it a good quality of life for some time. We also discussed that her husband had just had a heart attack and was in hospital 20 miles away awaiting a triple heart bypass, and when he did come home would need a lot of care at home. The owner was very upset, but felt that she couldn't take on the treatment and investigations her cat needed, and after much soul-searching decided on euthanasia, and I was in complete agreement that this was the right decision for her.

RE: Moral distress amongst veterinary surgeons

George Cooper — Sat, 20 Oct 2018 15:55:49 GMT

I recall a fair few years ago going to see the local village Doctor who, with his Doctor wife had spent a year's sabbatical in a remote and extremely poor part of Africa.

In conversation about how they had got on, and about their experiences, he told me of African women walking miles, in childbirth, to get to the Hospital/Surgery where they were stationed, to be found dead in the morning on the verandah.

He told me too of boiling binder twine in a metal cup in order to "sterilise" it before using it to suture wounds, using a needle that he had just re-sharpened on a convenient stone picked up in the grounds. He told me more, very sad stories that I've lost in the interim.......

I asked him then how he felt about treating me with my ingrowing toe-nail, or other some such trivial ailment (in comparison) and his response was succinct, telling, and realistic - something that could equally apply to those responders in this thread who get upset by feckless people, or ignorant owners, or impecunious clients, assuming a kind of moral indignation and high-ground when faced with such occurrences.

His response, quite simply, was "we cannot shoulder the moral and social burden of another ******". Insert "country/person/town" according to the situation.

The subtext is that he and his wife had committed to doing whatever they could for that year and so were indeed doing, but in essence they had "accepted" the situation was, in total, beyond their individual influence.

These are facts of life - that it can seem unfair, that it can be annoying, that it can be frustrating in the extreme, and that WE are irrefutably RIGHT. In everything. To those who rail against the poor, the underprivileged, the dense, the thoughtless and say things like "if you cannot afford treatment (and thus won't upset ME the vet) - then DONT GET A DOG" - just spare a thought for the OTHER times when those people don't need a vet - the joy and companionship that, in their situation, is their only reason to perhaps get out of bed in the morning. Sometimes we do ourselves no good at all when we choose not to see another side to the particular coin that has been tossed.

RE: Moral distress amongst veterinary surgeons

Lucy Fleming — Sat, 20 Oct 2018 11:11:20 GMT

[quote user="Julie Innes"]As far as "unjustified PTS" goes there definitely are those cases where you see an older animal fot the first time with a condition that would have been treatable had it been brought in 6 months ago but is now beyond help. So PTS is "justified" but you feel angry at the owners who don't give their animal the care and attention they should, especially when you see other owners who are willing to do whatever they can and it doesn't work out for them.[/quote]

I very much agree with Julie here, some of the ones that I find the hardest are ones that make you feel like someone failed the pet somewhere down the line (most frequently the owners for not seeking care sooner). We still see a fair few elderly pets presented for euthanasia for crippling arthritis, that we have never seen before and that haven't had any medication, ever. In that situation it's not so much that I feel the euthanasia is unjustified at that point (is usually is very much justified!) I just get frustrated that nothing has been done to improve the pet's quality of life. If anyone has any great suggestions for getting those owners to seek contact with a vet beforehand, please let me know!

RE: Moral distress amongst veterinary surgeons

Clare Tapsfield-Wright — Fri, 19 Oct 2018 21:45:17 GMT

The way I learned to deal with this , and I mean learn by bitter experience, is that we cannot save the lives of them all.

We cannot always save their lives but we can often save animals from suffering when we are allowed to, and that might mean PTS in an animal that could survive but where owners circumstances prevent it . I consider a peaceful painless death which prevents suffering as the only course of action I can take sometimes. If an owner cannot or will not pay for treatment that decision is theirs and is beyond my control and in such circumstances a good PTS is the only kindness I can give. We have to protect ourselves from assuming responsibility for the decisions and circumstances of the owners of our patients or we would buckle under the emotional onslaught. I am sure the same applies to those working with children. You can only do the best you can in the situation you find yourself.

RE: Moral distress amongst veterinary surgeons

Julie Innes — Fri, 19 Oct 2018 16:50:32 GMT

As far as "unjustified PTS" goes there definitely are those cases where you see an older animal fot the first time with a condition that would have been treatable had it been brought in 6 months ago but is now beyond help. So PTS is "justified" but you feel angry at the owners who don't give their animal the care and attention they should, especially when you see other owners who are willing to do whatever they can and it doesn't work out for them.

I admit, I get upset at lack of basic care. If you're not prepared to look after an animal, just dont get one!

RE: Moral distress amongst veterinary surgeons

Cool — Fri, 19 Oct 2018 16:10:34 GMT

[quote user="Neil Wheadon"]

[quote user="Kate Richardson"]Absolutely. I am one of those people. Doesn’t mean I don’t care or have no empathy, far from it. I’m not sure if it’s an inherent trait or acquired or a combination of both. [/quote]

Agree with Kate and further I can't really think of a PTS request that was unjustified, reasons

1) Attack dog, brought in because has bitten people, I don't think twice

2) Won't go for further treatment. I feel that many clients go through this once in their life where they have tried to take treatments too far. Quality over quantity.

3) Cost Issues. I came from a family that basically had very little money. £250 is not a small amount for many families.

You need to look at it from the clients point of view, they live with the pet 24/7, I see it for 15 minutes and if their mind is made up, I would never try to dissuade them.

Neil

[/quote]

I think I agree with you Neil. I tend to walk the same path as you on these issues

RE: Moral distress amongst veterinary surgeons

Lindsey Edwards — Fri, 19 Oct 2018 10:23:36 GMT

Does some of this professional disatisfaction arise from the self-awareness that things did not go in the practitioners perceived direction and that they failed the case/patient/owner/professional ability by not 'saving' the patient at all costs (financial, emotional and patient suffering).

The culture (more prevalent across the atlantic but also starting to develop in other places) of 'gold standard care' - intensive care treatment for critical and terminal patients and an overiding sense that vets should not only be able to but actually should ensure that all patients survive (regardless of cost, long term prognosis or indeed suffering) is likely a contributing factor to feeling distress at 'losing' a patient.

In my opinion - euthanasia performed well is not a 'bad outcome' - the patient does not, cannot and will not suffer from thereon out and although none of us like to lose patients prematurely there are many times when it is a very valid option for patient and owner. This compassion and acceptance seems to have become buried under 'medical advances' and this may be contibuting to a sense of 'failure' amongst practitioners?

RE: Moral distress amongst veterinary surgeons

Richard Carter — Fri, 19 Oct 2018 09:56:18 GMT

When we were students we had to wear white coats/ jackets at College. If the men wished to wear other clothing, a tie was expected. Of course as students we thought this was pedantic, out of touch and a pain. I really don't wear any white coat now but we do have a little uniform which makes me the 'vet' and other colours for other staff. I prefer an informal atmosphere in the surgery and believe it helps the stress level in clients and patients but it may be the 'call me Dave' culture means that the relationship is now personal and not professional and so opinions or trying to find the 'right' solution might be putting more pressure on people who cannot create a professional barrier?

Or is it the sweat shops where a person consults 5 minutes from 7-7 and it is plain exhaustion?

RE: Moral distress amongst veterinary surgeons

Iain Richards — Thu, 18 Oct 2018 23:33:50 GMT

The phrase, "moral distress" has been created by an author to promote their paper. Nothing more.

RE: Moral distress amongst veterinary surgeons

Neil Wheadon — Thu, 18 Oct 2018 18:51:33 GMT

Agree with Kate and further I can't really think of a PTS request that was unjustified, reasons

1) Attack dog, brought in because has bitten people, I don't think twice

2) Won't go for further treatment. I feel that many clients go through this once in their life where they have tried to take treatments too far. Quality over quantity.

3) Cost Issues. I came from a family that basically had very little money. £250 is not a small amount for many families.

You need to look at it from the clients point of view, they live with the pet 24/7, I see it for 15 minutes and if their mind is made up, I would never try to dissuade them.

Neil